and merits. will you please call the roll? yes i'll start with you president green. present vice president guglielmo. present commissioner chao. present. i'll note that commissioner guggenheim is here. commissioner gerardo present commissioner christian present and commissioner salgado present. >> i thank you and vice thank you and vice president gilmore will read the land acknowledgment.

thank you. the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the roma aloni who are the original inhabitants of the san francisco peninsula as indigenous stewards of this land and in accordance with their traditions. the army tisha aloni have never ceded loss nor forgotten their responsibilities as the caretakers of this place as well as for all peoples who reside in their traditional territory. as guests we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors elders and relatives of the ramit aloni community and by affirming their sovereign rights as first peoples. >> thank you. the next item on the agenda is the approval of the minutes of our commission meeting from november 17th 2025. commissioners you have before you the minutes and i believe there's one minor correction and if there are any additional corrections we can speak to them.

>> and thank you president green for point this out on page five. under commissioner comments first sentence. there's a word noted that should not be in there so i read this sentence as it should read and as it is now corrected. president green asked for more information regarding the medical staff who remain unaffiliated with us with ucsf. >> are there any other additions or corrections to the minutes? and i guess seeing none is there a motion to approve? >> and he says and is there any public comment on the public comment on this item or at the minutes? >> i see no hands in the room or remotely. >> excellent and all in favor please say i. i. all right. the next item on the agenda is general public comment and secretary mauritz has a statement to read. at this time members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the commission but are not on this meeting agenda. each member of the public may address the commission for up to three minutes. the brown act forbids a

commission from taking action or discussing any item not appearing on the posted agenda including those raised during public comment. please note that each each individual is allowed one opportunity to speak for agenda item. individuals may not return more than once to read statements from other individuals unable to attend the meeting. a written public comment may be sent to the health commissioner. the following email address the word health dot the word commission dot d at sfd storage if you wish just by your name for the minutes you may do so during your verbal comments without taking your a lot of time. please note that city policies along with federal, state and local law prohibit discriminatory or harassing conduct against city employees and others during public meetings and will not be tolerated. we will first take public comment from individuals attending the meeting in person . we will then take remote public comment from individuals who have received an accommodation for a disability. thank you. >> and is there a new general public comment in the room? see none. okay. and what about remote? there is a hand up.

give me one. >> are you there? >> yeah. patrick, hold a thank you and you've got three minutes. >> all right. i'm going to use my computer. >> here i go. thank you. >> this public comment is about two issues not on today's meeting agenda. so please don't cut me off first. i hope you commissioners read the letter i wrote to president green about the commission's streamlining task force potentially moving the health commission out of the city charter and into the administrative code which i asked mr. moritz to forward to you. being moved to the admin code would threaten the existence of the health commission because it could trigger a requirement to apply a three year sunset date that can shut down this commission. president green should follow the lead of at least eight directors of other boards and commissions and write to the streamlining task force to support keeping the health commission in the city charter. on behalf of the most

vulnerable san franciscans your own san francisco health network patients directors i should consider doing so to wait a year ago. i'm working on it doc and you all know i'm i'm still trying that again. the sunshine ordinance that was read by there's two orders that terminate asian will run in my name or on i'm come right that

i'm not oh no wait i'm quite about 41 seconds and you can always submit in writing mr. manager okay wait a. complaint about the meeting agenda when you go and quote ten minutes or more good form at three you should set a goal is not many more errors on the agenda.

about that remote dial and bomb number access code thank you. >> that ends public comment. well thank you very much for the letter and the effort you put into this and we will definitely review it so the next item on the agenda is the directors report director say this. good afternoon. today is world aids day december 1st and so i want to start with that which is a very significant date here in san francisco and i continue to love being here in the city with the legacy that we have here around hiv aids as we speak. i think a number of ucsf researchers are hosting. a discussion at the s.f. g on this topic. there have been a range of remembrances all across the city and i think i mentioned

this when the annual epidemiologic report came out that our team prepares we i think are still a shining beacon of what it is like to tackle. all in um uh not just hiv aids but really any disease state and the progress we've made is incredible and at the same time there's more work to do. i think there are about 146 new diagnoses this year. the data indicate that um there was an increase for women newly diagnosed with hiv and um and so there are range of things especially women of color and so there just continues to be a lot to do. i'm always amazed when i go around and see what our clinicians whether they be at ward 86 in partnership with ucsf or in the community or with you know our providers in our various clinics i was

walking in the tenderloin and came across some of our docs at um tom waddell the other day with one of our street medicine clinicians and they were taking a walk to lunch but their topic of discussion for a meeting was how to get folks started even more quickly on the new long acting therapies that are really, really promising from a convenience standpoint instead of having daily dosing required . so there's both the tremendous progress we've made across the city in really a model of partnership and there's a lot more to do. and so i just wanted to note that for the significance of today, two items in the director's report i wanted to call specific attention to we the department put out a statement trying to remember if this was last week all the data blurred together but in particular just reaffirming the safety of vaccines and the

importance of vaccination. i won't read the statement but we have put that out. a number of other public health departments have done similarly and we continue to emphasize that across all of the work we do at the department. and i also want to note i believe a mix of lavina and susan philip provided a little bit of this update last time as well. but we continue to be highly vigilant around the data coming out from the navy the hunters point, bayview bayview point shipyard, navy shipyard um i think folks were apprized last time of the information we had all received and federal and state regulators have received that information as well. um the press has covered quite a bit what has happened including our city and others continued alongside supervisor

and others a continued call to the navy for transparency and accountability around partnership for the data in a timely way. there was a community meeting held not too long ago where the navy shared a lot more about that data. they did apologize for not providing that data in a more timely fashion from the data we've seen the good news is we do not believe there's an imminent public health threat. the the the issue is transparency and immediacy of reporting around all of the data the state and federal regulators are reviewing the detailed data we all requested they actually at the state the state and feds are the actual regulators of this issue. they requested very detailed information and last i think we understand they expect to conclude their more detailed scientific review in the january timeframe

and supervisor walton has called a hearing on this in two weeks or so as well. so i just want to emphasize that we continue to be highly, highly engaged and that gives you just a lay of the land of different pieces. and then finally i think i wanted to take one minute just to recap some time ago i walk through some of the high level strategic priorities that we've been outlining um for that department and i just wanted to recap that and put specific emphasis on one of them which you will hear a little bit more about um on health equity later. but as a recap there are the vision statement for the department that we've been migrating to is a small modification of our current vision statement which is that san francisco would be the healthiest place on earth. it's a very bold vision. the modification of that is that we would be the healthiest place on earth for all people

for all people as the part that as a team we've um we want to add in and there are three major pillars from a content standpoint that i would say do not reflect the full scope of what we do as a department but our three very clarifying pieces. the first is that we would demonstrate what it is looks like to get to zero. it is world aids day to get to zero on a set of health disparities over a 10 to 20 year period. um and we have been looking at the data where we are truly indeed a very, very healthy city compared to the rest of the country other large cities ,the rest of the world where we struggle is on a set of health disparities and that is the place where i really want us to show folks what the san francisco bay can look like. and there are a few areas we're still kind of looking at the data on. one of them is we want to look

at kind of premature deaths overall potentially related to cardiovascular disease which are account for four of the five most common causes of death right now in the city with a large disparity particularly for black african americans. the second area we're honing in on is overdoses which relates to the behavioral health work which is the second largest cause of death on an absolute basis in the city. and from a disparity standpoint, black african-americans are five and a half times more likely to die of an overdose which amounts to somewhere between 180 to 200 black african-americans dying above the population average from overdoses. so you can quantify that number. and a third area is around preterm birth and maybe a broader set of maternal and child health outcomes where again we can quantify those disparities in numbers of babies born preterm and the disparities that exist for um a

person of color for example and in particular black african-american births and so tackling that is a thing that is quite exciting to think about that will go beyond just the levers that we have as a department but we are really trying to orient in a data driven way how we pull a range of public health levers in coordination with a broader set of the community, other departments and others. so that's the first one. the second one is being the best health care delivery system in the world. a lot of the work that we do even on the behavioral health space on the primary care side thinking about access all across the city including in the bayview to primary care for example are quality scores all of that go into that second category and third is tackling the behavioral health and homelessness crisis of what you've heard quite a bit about from us and then some of the cross-functional things underlying that involve thinking about our data and really driving our

decisions based on evidence and analytics operational and contract efficiencies and financial sustainability and how we really have a performance monitoring view to things is another really engaging the community and in various communities in a more systematic structured way across the department as a as another investing in our people and our workforce is another and there's a range of those that cut across. so i just wanted to note that as a reminder as you hear many of the different presentations over the coming months of the different parts of the team and i believe the office of health equity is presenting today as well. >> and so i think that i hit my notes here. yes, that concludes my report for this week. >> thank you. well, thank thank you so much for the excellent report and that outline of the goals and the true north that was really superb. we heartily endorse everything you're doing and know that the team put in a great deal of work to really cut to the things that are most important

and that we need to aspire to achieve also for highlighting world aids day that's that's wonderful to review. is there any public comment in the directors report in the room? >> is there any i don't see any hands in the room and i see no hands remotely. and what about commissioner questions or comments? i see commissioner christian's hand. >> thank you. president green hi director. thank you for the report on the navy yard. appreciate the department's engagement there. can you tell us any more about the upcoming hearing that supervisor walton is planning and is there was there any is there any feedback that you can give us from the navy about why they delayed in providing this information? >> so i, i will be present at the hearing. i know and the supervisor and i chatted about that.

i believe a range of folks have been invited by the supervisor including the navy around that and on the latter piece again i don't i don't want to speak for the navy. what i can do is just recap their presentation and what they went through and the community meeting they did apologize for the delay and for not sharing the information more quickly. the stated reason they provided again i'm just recapping what they shared in a public meeting was that they had as i understand it they said one they had what they thought was potentially an anomalous reading because they had two. one was a positive, one was a negative essentially and they felt that they wanted to take more time to assess the data and two, they said the positive reading even though it was above an action level it was so low that it was less than even if one sustained that amount of

radiation continuously 365 days a year it would be less than or equivalent to a cross-country airplane flight. so i believe those were their reasons. i think our point of view and my understanding of the regulators point of view is that even if those things are true, one must report data timely and transparently. that is part of the whole point of all of these pieces and so we appreciate that explanation. we appreciate which is why we've said at this point we don't believe from what we've seen that there's a public health threat but the issue really is about full transparency in a timely way to the community with the data and especially to the regulating agencies which are a mix of the epa and state level agencies. those are the agencies that should be making a determination of whether or not something you know how to interpret between a two conflicting readings or whether

reading is worrisome enough or not. and we want to make sure that process is really adhered to. >> other commissioner questions or comments i guess i only have one then which is some people were very concerned about coverage for vaccines and that's not only people who are within our health network but also individuals who are insured. i think kaiser people feel pretty comfortable what about individuals who for example are on the exchange plans? can we make any comments or public comments about whether they should worry that their vaccines may end up being out of pocket expenses this summer or quite quite costly? i would say again i don't want to speak for every health insurer but california has taken a range of actions here. so the issue as folks know is that the cdc and the advisory panel acip which advises on kind of vaccine policy to the cdc has taken a different view

than historically in the past which is of concern to many of us in the public health community. the recommendations of that have implications therefore based on both what's required in the aca in search of what health insurance and insurance companies are required to cover. now in california, anticipating that the state passed separate has said don't quote me on the exact set of regulate the state has done things including with a range of western states that really point to ensuring that here in california health plans to the broad extent should continue to cover vaccines and so there's no prohibition about them covering that. and so to our knowledge along with our other public health colleagues coverage of vaccines is not has not materially changed in any way here in california and we're grateful to be in california as

a result. and our message has been to folks go get vaccinated and there have not been any meaningful changes that we are aware of for health insurance coverage in california of vaccines. >> thank you. and then i guess the only other question i have is you know, the epa has been so decimated and all the national regulatory organizations do we have any concern about either the staffing or the ability of the epa to really carry out their part of the responsibility to ensure that things are being done transparently and effectively at the naval shipyard? >> so i mean i think we always have concern when any federal agency that has a really key regulatory oversight role that all of us rely on from a safety standpoint especially here for the bayview hunters point community. but i would say the epa has been quite engaged as have the

appropriate state regulating bodies and we submitted a data request to the navy, the regulating agencies submitted a request appropriately that was substantially more detailed than the data request that we submitted. so i'm glad to know that they are all reviewing. they've also made clear that we should stay in our lane which is we are not the regulating agency. so we we we are commenting as i have commented as we have commented that we want transparency. we are here to advocate for and care for the community. we do not see a huge public health issue. we see an issue around the transparency and the timeliness but that really is not for us to say and i think our regulated colleagues have made clear they would like to weigh in. so we are we are trying not to step into the way of that and as i noted, our current understanding is with all of the new data that they requested, the regulating

agencies will have a better point of view in january based on the data that the navy provided. oh thank you. any other commissioner questions or comments? all right. see none. we will go to the next agenda item and that is the revenue and expenditure projection report for the first quarter of fiscal year 20 2526 and drew merle will present he's our chief financial officer and excuse me drew and subject to i'm pulling up a presentation please show it on the screen it's on my way back . >> just let me know if you need to do anything else with it, okay? please let me know if i'm not speaking loud enough, i'll endeavor to speak right into the microphone. >> thank you. afternoon. thank you for this opportunity to present our first quarter financials which is a projection of where we expect to end the year relative to budget and variances both on the expenditure side and the revenue side goal here is

really just providing a clear summary of how we're performing relative to our budget and what's driving the major variances what we're monitoring closely as the year progresses . >> second slide. >> so here in the first quarter summary i'll draw attention to the bottom line number the revenue the slight variance about 13.9 million in total which is about 6/10 of 1% across the department and then we expect expenditures to be on budget. and if i go to the next slide. so as i said, bottom line we expect to expand in the year on budget for expenditures so we don't anticipate needing a supplemental appropriations and we that still means that we need to closely monitor as we go into the divisional record we'll see there's areas of concern, areas that we're closely monitoring to make sure our spending ends line ends the

year in line with budget. on the revenue side we have the small positive variance of about 13.9 almost entirely due to one time adjustments in behavioral health claims processing and then across divisions i'll go into detail but zuckerberg san francisco general shows the largest dollar variances because of its size and other divisions as we'll see have proportional larger swings. but since of is an outlier because of its in absolute terms. so next slide. so starting at g we can see a significant revenue variance of 51.3 million 49 basically 50 million of that's from medi-cal and medicare really we can see a correlation there with lower than expected patient volume and census during the same in this quarter relative to the same quarter prior year about

9% reduction overall. some of that is offset with improvement or positive variance in outpatient pharmacy revenue which continues to perform well and other operating revenue is also under budget by about 11 million reflecting factors such as higher than expected intergovernmental transfer payments and i appreciate the question. i'll get into some of that a little bit more detail in a minute which affect timing of the revenue received and then a shortfall in capitation revenue of about 4.6 million. so i appreciate the questions that i received and i'll endeavor to answer them starting one question here came in about when will it be clear if congress will delay dish cuts and if delayed for how long dish is our claiming program for claiming getting reimbursement some level of reimbursement for the costs of providing uncompensated care

it's currently received through the global payment program gbp but it's still underlying funding is provided through dish which requires congress to fund every year. we know that it was funded in the continuing resolution approved by federal congress on november 9th. that's through january 30th. so certainly something we'll be monitoring closely as those negotiations continue. another question i received please explain intergovernmental transfer payments. so and how does how do they relate to our quality incentive program payments so intergovernmental transfer igt payments are really just the counties participating in medi-cal reimbursements but us contributing the local match for medi-cal. our q1 projections include

increased igt payments relative to what we expected in the budget and that's due to a change that california department of health care services dhs implemented or announced in july 2025 related to the share of people with unsatisfied immigration status in covered medi-cal managed care plans. so overall it does affect these programs in particular as relative to budget but that's something communicated in july so and then finally is the capitation revenue directly related to primary care? the so this is the $4.6 million reduction or relative lower than budget revenue expectation . >> so pointing out here we we receive capitation revenue for both healthy workers both in terms of facility which is inpatient and professional some nims reimbursements for medi-cal enrollees as both for

and within the nims network and then facility and finally directly with the health network. >> so we have a broad pool of patients that we receive capitation revenue for and this 4.6 really reflects that some of the particularly in the professional side we have greater than expected out of network costs affecting our reimbursement. next slide please. >> so on the expenditure side xpg is projecting a negative variance of 25.5 million so costs are running higher than expected. these are across the board really personnel costs, professional services, materials and supplies. >> you know, one underlying thread through all is these are areas affected by inflation as well as persistent salary

pressures which are as colas are rolled through our budget covers the salary increase but or as part of the budgeting process the mayor's budget assumes the cost increases as a result of colas but then does not budget for the cost of premium and overtime. we and through the budget that you approved did include an investment to pay for those increased costs and unfortunately the costs continue to outpace and we see a negative variance in our projections. this is an area we are monitoring closely. we think it's tied up oh the area that we see the biggest variance in salary costs right now is tied into our use of per diem nursing. so there are several interventions underway to improve tracking and oversight of pretty and needle ization

and we project these mitigations having effect during the course of the year to get us to the 25.5 million. but certainly that is something we are monitoring closely. and finally we do expect that we will need to rebalance csf g to budget at year end by moving savings from other divisions. part of the way that we get to zero across to the department is taking some of the savings from other divisions and smoothing out some negative variances for instance at csf g in this case a couple of questions to get to. so i. commissioner chow thank you for the question. csf g has fewer admissions and increased use of per diem kind of what's driving the use of per diem essentially and commissioner green along the similar lines since this is often above expectation for med surge and vacancy rate is lower with fewer patients and full staff what services are per diem?

where where is the use coming from? so i would say just one point to note in the way in the numbers that we're seeing we do see not as big of a drop but some drop in med surge census at the hospital from comparing same quarter to quarter prior year to current year but certainly much less and nevertheless we still see sustained increase in the utilization of per diem nurses. one thing that we know as of now there are cases in areas such as psych emergency where per diem staffing is helping to mitigate gaps in staffing models for other disciplines and projections already assume that we will rebalance with increased use of techs staff to help fill those roles and decrease use of per diems. more broadly we are trying to get our hands around monitoring the use of per diems and that's something that is a point of focus over the next three quarters just to land this 25.5

million in deficit. next slide. >> so laguna honda is projecting a strong positive revenue variance of about 23 million which is 8.5% above budget largely due to one time increase in the supplemental payments for calendar year 2024 and 2025. >> those payments in isolation total 25.8 million and are not ongoing. this revenue variance is partially offset by a projected $2.8 million deficit in patient revenue. and thank you for the question commissioner green the the census expectations for behind this revenue number assume that we achieve full revenue for full patient census by fiscal year end. the budget had assumed that it was going to happen by calendar

year end. all of that say we are focused and on point in bringing laguna back to full census well prior to fiscal year end but all that roland and dale to speak to that in more depth on the expenditure side laguna has a positive revenue variance or expenditure variance of 3.6 million largely from reductions to overtime utilization and a small negative variance from non nursing registry. next next slide please. >> for behavioral health this in turn in percentage terms i think is the largest swing for revenue. so we are projecting a $37.9 million total positive variance about 13% really broken into three factors. first one time accelerated quality assurance

and utilization claiming so a change with the state post payment reform allowed a one time acceleration of our quality. secure your claim that will not be ongoing. >> second there was prior year growth so more revenue that we needed to recognize from prior year claiming than previously anticipated and that totals about 11.5 million and finally continued there is some continued strong growth in units to service for outpatient programs totaling about 10.5 million. so partially true service growth but the majority of this revenue variance is attributable to one time temporary revenue that we received this year on expenditures we show $11.8 million of positive variance savings reflecting lower spending on prior year contracts that we were able to close in the current year as well as projected

pharmaceutical savings. next slide. primary care is projecting a small negative revenue variance of about 900,000 mainly due to lower than budgeted capitation revenue and lower slightly lower than budget qip quality incentive program revenue. on the expenditure side, primary care expects to end the year with a $2.7 million positive variance primarily due to vacancies and pharmacy slightly lower than budgeted pharmaceutical spending. next slide please gel health as where almost more than six months in to claim enrollments we are seeing very positive revenue news and positive revenue variance of 3.8 million from those new billing

opportunities under kelly and justice involved. and the expenditure side a we're seeing projecting a negative negative expenditure variance of 1.9 million mostly tied to pharmaceutical costs. so as as people leave the jail part of justice involved kelly included providing people with a 90 day supply of pharmacy needs as after every discharge that an increased census at the jail has driven pharmaceutical costs higher than expected as well as slightly higher than budgeted personnel costs about 300,000. so specifically one question thank you, commissioner green. >> some divisions yielding a positive noting that some divisions are yielding up positive variance in pharmacy including csf g and vhs. in others jail health art so why is there that discrepancy? >> i just want to highlight that these are variances from

budget which have gone through some changes this in 2526 we looked at our utilization of pharmacy spend and really tried to recognize put budget where the spend was happening so we moved a lot of budget from other divisions to zig-zag and shored up a lot of what was a continual deficit at csf g and pharmacy spend and that seems to be bearing out what was not fully anticipated in the budget but we're able to make up elsewhere was the impact of both the increase to jail census as well as the impact to justice involved requiring a higher utilization of pharmacy at the jail in particular. next slide. >> so health network services has a small negative revenue variance of 200,000 tied to fees related to the city's health care accountability ordinance.

that that and that revenue variance is tied to a payment reversal for a single employer which was that that large employer went through a review by lsc which found that the employees that were tied to those payments were not covered under the hca now and therefore no fee needed and those those fees had to be refunded that's than 200,000 variance. on the expenditure side for h.a. there is a significant positive variance of 13 million sorry really largely driven by position vacancies and then complemented with additional prior year purchase orders or encumbrances we were able to close related to the epic project in particular. next slide please. population health population health has we're projecting a positive revenue variance of about 1.6 million. this is stronger than expected

billing at the public health lab which post epic go live we were able to turn on and achieve much better results from on the expenditure side we are seeing $6.7 million positive variance and expenditures largely driven from vacancies at 3.4 million and contract savings at about 1.4 million. and next slide please. >> so for public health and ministry we see a ten we're projecting a $10.4 million expenditure deficit negative variance largely attributed to unexpected temporary staffing needs across administrative divisions as well as partially from reduced indirect cost recovery from grants. so we're actively reviewing staffing and grant strategies to bring the deficit down. and then just some more detail on the grant on the negative

variance for grant recovery, the total project and negative variance for the four unrecovered indirect cost savings is 1.5 million just to be specific with what this is is every grant that receives typically has a portion of it that's available to pulled back some indirect cost recovery. so this negative variance of 1.5 million reflects grants that we had budgeted to receive the notice of award and by now we have not received that or we don't see the same level of spend that we expect. the caveat here is this is this is a very volatile source and i think for the last two years running has produced surpluses at year end. i think the 1.5 million is probably a conservative number. we are monitoring it closely and especially as grants come

close to their end. we find operative we hope to find opportunities for more indirect costs claiming for any grant that's under subscribed or underspent and there may be additional dollars we can claim but certainly monitoring closely. finally next slide. so on the management on the revenue management reserve, this just reiterates we were able to fully as stated in the q4 presentation fully deposit to bring us up to our max level for the remainder management reserve which is our our revenue reserve available for buffering against short term revenue variances. and then just to summarize some key takeaways. we are on track to finish 2526 on budget. the small revenue surplus is largely tied to one time adjustments and not ongoing changes and we're the key areas that we're kind of thinking of

really are monitoring personnel spend at csg, the census trajectory at laguna honda and making sure our revenue projections are aligned and really the indirect costs claiming for those grants, making sure that we reflected that in our projections as grant awards come in if they are funded or not. happy to take any questions and hopefully i got to most of them. >> well thank you for the good news about being on budget and also i mean this was is really a significant amount of data that you have distilled into a really concise and clear report. we really appreciate it. things that seemed very confusing are understandable now and we appreciate the answers to your questions. >> any public coming in the room not seeing your hands remotely or in the room? >> all right. what about commissioner questions and comments on the budget? >> commissioner gerardo, i have one question just on your last

comment that the budget is better than i mean it's good, it's great but it is also based on some one time funding in so as you're planning for the 2627 is that one time funding throughout all of the different departments it is pretty significant and so that gives me pause so to speak for the next round of budgeting and i am assuming that's what you're ,you know juggling with at this particular time in going forward in the at the next budget. >> it just is of concern. i think that that is and for for me that is the area that at a high level is the area of concern we can see at the end

of the day we have a $13.9 million net surplus but underlying that a lot of it is one time sources and we would see a slight revenue deficit probably if we were only looking at the ongoing revenue in particular the that could be oc if what we were seeing at particularly at the hospital since it is our biggest spenders in terms of volume is the largest where we would expect to see a decline in volume experienced on the revenue side benefit from some decline in spend on the expenditure side and so that is an area that we're looking at very closely to make sure that the utilization is carefully monitored and thoughtfully calibrated to what we need. but absolutely i'm glad i'm glad that came through and that is what we're focused on. other commissioner questions or

comments on the budget everyone so quiet today. thank you so much. thank you all right. >> we will go to the next item on the agenda then which is the office of health equity update. we've been looking forward to this and naveen ababa, who's our deputy director of health and acting or director and jenny jackson who is the deputy director of the office of health equity are here to inform us. >> all right. i'm sorry as i've got to we have another presentation. >> there'll be a presentation for this item in the next item please pull them up. >> great and good afternoon, commissioners. my name is naveen ababa. i'm the deputy director as well as the acting health equity officer and i will be joined in this presentation by jenny chacon, our deputy director of the office of health equity.

>> i also want to acknowledge that gavin and vincent from the office of health equity are also joining us in the room today. and next slide please. so the agenda for this presentation is we're going to talk a little bit about some of the disparities work that we are doing. we're undertaking that director sai talked about in the director's report throughout the department and then we will talk about the community health assessment and some of the work she is doing there updates on the racial equity action plan and phase two planning our cbo deep budget process that has been ongoing since september and some of the priorities that ohc is looking at in terms of following metrics. >> next slide please. so the office of health equity is under me under the deputy director and it reports to me currently that position is vacant. it is a managerial position that has been approved

internally but is being it is at the mayor's office waiting for approval. >> next slide please. and this is the current structure of the office of health equity. it has three main branches consisting of community programs, equity and cultural programs, equity and culture programs are more internally focused and then the health disparities research and policy team. next slide please. >> and so on this slide is i think as you all know, departures, mission and vision and departures. my mission is to protect and promote the health of all san franciscans and his vision is making san francisco the healthiest place on earth for all people and she underwent a strategic planning session in 2023 and 2024 and it has the same vision with a little bit of an equity focus to make in order to make this the healthiest place on earth by supporting to address health

disparities in health inequities and to protect and promote equitable health for all san franciscans. as director size stated, one of the main goals of each is to get to zero on health disparities over the long term by deploying world class systematic public health interventions and this includes upstream interventions tackling social drivers of health and community engagement. next slide. so i wanted to focus a little bit about on the data of san francisco. san francisco is a healthy county and it ranks among one of the healthiest counties in california as well as the country. the average life expectancy is 82.3 years. it under many indicators and when you compare it to the big cities coalition we rank very healthy compared to other city big cities across the u.s. there is a high insurance coverage here and there's access to a world class health system.

yes, there's positive population health indicators including high physical activity, low smoking prevalence. >> there are lower rates of chronic disease as compared to other cities and counties across the nation and it has lower than average mortality rates from most causes. >> it has major achievements in public health including our covid response. it has high vaccination rates. we are a national national leader in hiv prevention and treatment and we have made significant strides in increasing our behavioral health access and treatment both on the mental health and substance use side. next slide please. >> however, there are enormous challenges as well the population level success mass profound racial and neighborhood inequities these inequities are driven by structural racism, economic exclusion, housing instability and uneven access to culture responsive care as you can see

on this slide specifically while the life expectancy is quite good overall there are profound disparities that black african-americans have a life expectancy of 66.4 years and native hawaiian and pacific islanders have 71.3. so both those communities face high burdens of disease and the latinx and asian communities also have worse outcomes in specific areas. >> next slide please. >> this slide is showing you our 2024 community health assessment. this is this is developed and produced by a population health colleagues. and so at the top you will see the top ten causes of mortality within san francisco. the left side shows 2019 as compared to the right side which is 2024. >> and one of the things i want

to first note is that drug use disorders went from being the eighth cause in the 2015 to 2017 cha to now the second cause of mortality and the 2019 to 2021 cha that's when the data was collected. >> and as was noted if you look at the the current data one through five outside of the drug use disorders really are on the vascular system specifically the cardiovascular system as well as some cerebrovascular mortality. so if we think about how we are going to tackle disparities, there's a couple of different ways you can look at this. one is what are the things that people die of and the most common causes as we have talked about in the top five causes one is drug use disorders. the other are the vascular system. i will also say drug use disorder death tends to happen in a younger population. and so that's one of the biggest causes of years of life

lost productive years of life loss whereas the cardiovascular diseases tend to happen in the elderly. so in drug use disorders we generally see people dying in their 40s and 50s and the bottom slide you will see are in the bottom part of this slide you will see that within these top five mortality causes there are also racial disparities the most profound of which is the drug use disorders the kind of yellowish orange number is the black african-american death rate due to drug use disorders. it is five times more than the average rate and then but all the other four causes as well do have racial disparities as well. >> so this graph shows why one of the things that we really want to do is focus both on overdose disparities but also on cardiovascular diseases. and in terms of looking at this

data, i think the next step that we really need to do is determine how we can get much more granular. we do know that in terms of drug use disorders people tend to die in soma in the tenderloin. now if that is that where they live those are some of the deeper analysis that we have to do in order to target the interventions and then cardiovascular disease as well. on the flip side of that is we have to get a little bit more granular on the data to understand the tactics that we want to use to decrease these disparities. next slide please. >> and then in terms of the life course, you know, we talked about cardiovascular disease but even though it causes the most mortality, it does impact the elderly drug use disorders, middle age and lots of life years loss. but we also want to work upstream and make sure that you know everybody in san francisco who was born in san francisco has the ability to live a very productive life throughout their life course. and so when we look at m.s. at

our maternal child and adolescent health data, one of the other places that we see a huge disparity is in preterm birth. preterm birth is defined as birth that occurs below 37 weeks of pregnancy. it is one of the causes of mortality and an infant. and so you can see the disparities at the top page where black african-americans are at 16% and really have a much higher rate than the other populations. >> so focusing on pregnancy and birth is one of the highest impact places that we can have a population health strategy because it represents a critical window of interventions that can dramatically change someone's life course and that includes not only just having a healthy birth but a healthy pregnancy as well. >> so when as we have thought through the data and where to focus these three areas have

come to a place of where we want to put our energies and to really make a difference. overdose deaths, preterm births and heart health and one of the things that is now occurring is with the community health assessment the data that you just saw in the previous slide is that is now going out to the community to look at these different data sets. and from the communities perspective where they see the most concerning trends in health and so we will also get that feedback from the community and deputy director chacon will now come up and talk a little bit of more about that process and then i will come back at the end. good evening commissioners. so we are going to give an overview of the sfe voices. i think last time i was here with a pilot and this time around we partnered with our population health partners for the cme health assessment to reach out to communities that

traditionally are not reached through traditional outreach or surveying like the community health assessment. so from may to august ohsu partnered with these operations and public health emergency response team on town halls. so in general we've been trying to work more streamlined and collaborative across the organization for community work because our community they see us as one organization. so how do we utilize that and not duplicate efforts were already going so we collaborated on townhalls which included a focus on reporting back to community members and gathering additional survey input on top priority health issues that were identified in the charter. >> next slide. >> so the team went to seven neighborhoods with traditionally high disparities such as the bayview sunnydale visitation valley civic center, mission tenderloin and western

addition. and they partnered with 11 community organizations to do this work. as we take a closer look at survey respondents, we were able to reach a broader and more diverse audience. we collected some unique data with indigenous community from latin america which traditionally is not picked up due to the hispanic latino demographic category or language and the population included having this sample. older age groups due to outreach conducted at senior centers. next slide. >> so what we what the team did is they asked at these town halls they were asking the community to rank their top health concerns using the categories from the cha and the five areas of highest health concerns closely aligned with the disparities outlined in the cha. and just some findings that we found in these smaller groups american indian, alaskan native hawaiian pacific islander identified both heart health

and mental health as their top health concerns. it was tied for first and the most consistent health concerns across multiple groups was mental health. we can't generalize these conclusions because of the limited sample size but it does give us an idea of where we need to work with the community to research further. and this will be done through the community health improvement plan which is the process to operationalize the choice findings. next slide. >> and i wanted to give you an update on the racial equity action plan which we call the reap. these three areas are the focus areas from this past year. first, based on the employee engagement survey results where staff responded not feeling respected ohv h.r. and laguna honda collaborated on creating and piloting a training focused on creating an inclusive and respectful work environment. the respects training is a

supplemental training which focuses on applying the city's equitable, fair and respectful workplace policy. >> in january in january 2025 there was a pilot that was implemented at laguna honda. based on these and the pilot learnings there was a training that was formalized and then carried out as esg. and this resulted with a total of over 1000 staff participants across the areas listed such as laguna honda's esg and there's been a ten point increase in overall staff reporting feeling respected in this year's employee engagement survey since it began being tracked in 2019. second, our h.r. partners continue to focus on internal career advancement by focusing on classifications traditionally overrepresented by underserved communities communities of color. >> and then for our third area we focused on partnering with

h.r. for the 2025 employee engagement survey with dr. barba acting as the executive sponsor. >> so moving forward ohsu and h are partnering to identify and address employee survey disparities for deep wide focus areas such as safety, adequate staffing and respect which i will discuss in the next slide . >> so as i mentioned in 2019 ohc integrated racial equity survey questions into the poly engagement survey. and overall there's been increased improvement across almost all areas. this includes the overall ten point increase in staff reported feeling respected. however, when we look more closely at the data we find that there continue to be disparities among black african-american and latino staff. our equity and culture team as a result will be part is partner with h.r to identify and address racial employee engagement survey disparities. from the top to survey priority

areas and disparities in respect this will be included in each division's survey action plan so we're working to ensure that that equity focus is integrated. next slide. so here's a preview of phase two for the reap phase to the report include external engagement and the continued focus on internal policies and practices like workforce which we've been doing for the past four years five years in august and september oig conducted an internal self-assessment across divisions and teams that engage in community or patient engagement for the first time with a defined framework. and our purpose as we wanted to gain a baseline understanding of how different teams define community engagement their activities and just deep ties current state with doing community engagement work. and the goal is to ensure we have a more collaborative

process where community stakeholders are brought in at the earliest stages to co-design and share decision making so that we can identify problems, generate ideas, shape solutions and test and refine them together. >> so our results so far were as an organization we came we scored the three out of five which is the involved level meaning that the department engages communities to shape organizational plans through groups like advisory boards it might not bring. it's still our plan but we're bringing and it's not necessarily equal it's engagement but it's not starting from the beginning but bringing in more in a group setting we will use these learnings to develop an internal infrastructure to ensure a systematic approach to community engagement across page reduce silos and duplicative efforts. this includes developing an action plan with specific steps outlined which will be part of efforts.

and now i'll pass this along with dr. bala. >> so i'm just to continue with a theme on our community engagement. we have taken a a different approach this year under the direction of director ci in terms of engaging the community around our cbo cuts. and these cuts are actually from the last year's budget where we still have an ongoing $17 million cbo cut that we have to make for next year for 2627. >> and so we have had a total two total cbo meetings to talk to them about how to approach these cuts and what we've done in there. and i really wanted to thank my finance colleagues who have been doing most of the work around this have created principles as well as a way to approach these cuts and have talked to our cbo partners with them. >> so the principles are really around transparency and communication and focusing

on our core mission strategic alignment equity centered decision making and data informed choices and those principles we've taken and done a rubric to look at, you know, the contracts that we have and how much they are meeting some of these principles and the rubric you know part of it is for example on the equity focus is this contract addressing a specific equity initiative and is it producing the outcomes that we want it to produce? so there's a ton of work that is happening across the department with finance and our contracting divisions to determine some of these very tough decisions. and director ci has presented at both of these cbo meetings and has been very open and honest that we don't have any you know, secret tool that we have. in fact we have not made decisions yet and these are all tough decisions and have has welcomed inputs into the rubric

that we have created. and so those have been really good conversations to have with the community knowing that these will be difficult decisions. >> and finally, i just want to end with a cheese focus. so the health disparities work that i talked about is just getting under way across the department. as stated, we are looking at the data internally and there will be also that external focus with the community health improvement process or the chip and then the you know when we kind of finally land some at some place that these will be huge collective impact efforts and most all three of these require significant internal work but also work with our external partners as well not just with cbos but with other departments. and as we know the social determinants of health include housing include income economy, you know access to green spaces and that lives outside of the department. so once we get on to former

ground in terms of data and where we want to where we're geographically, we want to intervene in the numbers that we need to treat to decrease these rates. we will then work on developing that collective impact backbone. but in the meantime oig has developed action plans and to not let you know the perfect be the enemy of the good and what they have done is in terms of addressing the disparities, looked at the data that we're already collecting and trying to follow on the interventions that we are currently doing and seeing if those will make any impact. and then as jenny said, there is also engagement around community impatience and following some of the metrics both on our community side with our community partners but also on patients. and there is a whole group of in the network that is looking at patient engagement and then internally creating an equitable culture for all which is really the work of our employee engagement survey as well as the reap and that is

the final side. >> we are happy to take any questions. >> well first of all what remarkable progress i think and we really have to thank you especially dr. baba because you've been i know wearing many, many hats and to see this amount of progress from the team and under your leadership especially when you're really in the interim is really quite impressive and you've obviously analyzed a tremendous amount of complex data and you have a path forward and this was just an excellent report. so thank you so much. is there public comment in the room not see public comment in the room or remotely? all right. >> what about commissioners questions or comments? commissioner gerardo, first of all i want to thank you for answering most of my questions that i had submitted but on the last on slide 17 which in fact was one of my questions too i'm

hoping as things roll forward if you could toward the office give us you know, some of the specific game plans so to speak. i think i'm always liking to translate as i said more abstract into concrete steps. yes, decreasing preterm births let's in the collective impact model exactly what are those steps? you know things things like that i think would really help us really for all of the different areas that i think would be you know, some of the next steps possibly would be would be great. yes, absolutely. and i think a lot of this right now as you're seeing is a lot of data review and analysis and then getting into that more action oriented part of what are we actually going to do now that we know about the diet? >> thank you, commissioner salgado thank you.

thank you for the presentation. i'm i always like these kind of surveys and all that great. >> so my question comes on page 11 when it says indigenous from latin america and then latin x i always have this weird feeling about it because as a latina who's indigenous where do i go? what all along what's you know is there a way we can uniform this where maybe it's like latinos or latinas, latin x and then the subcultures that come you know, afro-latino after you know, asian, latino, indigenous because like just reading this i can mark several and it just i just want to make sure like the latino community is represented but we're represented in a way that makes sense to us and i don't know if there's a way yeah. >> so it's two things like one like when we're looking at our

medical records or the records we keep we're using the or the omb, the census category right now we're still on the old one which is which is the omb to question like are you hispanic ? latino, yes or no? and then you pick your race and then there's a new combined one which would be like the ethnicity and race that has it ruled out yet but that's that's a whole other story. yeah and then also too it's what the community is doing so what we did with this voice is it provided us the opportunity to tailor and work with the community and ask the way that we would get that information from them because one is just the format is you have to ask it. there's a nuance away. one is trust like they're not going to admit in latin america ,you know, to be a guatemalan. so you know, they're not going to admit to be like indigenous even though everybody is and then the ones so they're going to say latino right off just because they've had that type of discrimination and there's different languages. so we did tailor that survey to ask in a nuanced way with that we would say like okay, are you

do you speak another language? and with the community the indigenous ones so that we were able to at least say like okay they're actually not latino, they're indigenous. so there's a nuance way and they have even in the surveys in the community even asking like okay so we know you speak another language, you don't say dialect that's very like insulting. then you ask them where they're from and so you can to kind of track it they say like i'm from guatemala. they'll say it's probably mom or teacher and those two languages. so that's how it we did it with this survey. but on a system level yeah it's challenging because we have all these regulatory requirements and medical record. >> i just i feel that the numbers would be different if better representation and just because we do fall into so many categories. yeah you know and it's it's hard to track i mean if we really think about it it really is hard to track because you

know you can be of so many different ethnic backgrounds and still be latino or latin x yeah so we're looking at that right now especially with the real data because like i said it's on the old classification and there's a lot of other so because me when i fill it out i say yes i'm latina and in the race i'm like other you know or maybe yeah so that is the current one that we're still in and so the new o and b categories will have a combined and they have more race and ethnicity combined and even to like for our middle easterners are taken out of whites and then they have their own category well i'm happy to see indigenous from latin i mean yeah we're trying yeah. >> thank you vice president guillermo thank you for the presentation and i agree with president green that tremendous progress has been made and it's

really sort of very encouraging to see where we're headed and that in fact the reap is going into phase two because it's been a couple of years and i know for a lot of different reasons but really sort of looking forward to that and in some ways i guess it's the experience we had with covid and some of the other things preceding being able to go external with the action plan informed us i think a little bit better about how you know how we might gather the data and do the community engagement and so on because moving forward it's going to be so much more difficult than even in the past couple of years. so just sort of a comment on that and also encouraging is that your finance colleagues and the the contracts folks are part of this i think very in an

integral way because one of the things that i think from a commission standpoint we've always wondered is how does the programmatic and the contract financial pieces really sort of move in the same direction in terms of the kinds of things that we're we're actually looking for a in the investments that we're making in in the community informed by community but also sort of justifying you know, the the kind of role of oversight. i think that we have had to play some really, really encouraged by that full integration and and looking forward to seeing how that comes about. so seeing the community health assessment all of the data that's being collected that really sort of i think was made more robust by unfortunately the pandemic and other things

and then moving into this next series of phases would i think i think in line with i guess the strategic priorities that have been identified really gives us i think a lot of hope for reaching that mission and vision that the department has outlined for itself in particularly in terms of for all people. but the specificity i think is also what we're going to be looking for and then the the goals and objectives outcomes related to that specificity reflected in not just how the data is collected but how the budget is allocated and implemented and monitored. so really looking forward to this really great steps forward . >> thank you, commissioner chao yes, thank you and thank you for this really wonderful report. i think it does show the

culmination of several years of anticipation of of what we are really going to do with the issue of equity. and so i actually was rather surprised but it's three the survey comes out that cancer was not one of the community's concerns but maybe that's good for our work in cancer where the numbers have dropped. but that might be because several other things have actually shoved it down further . and so i'm a little concerned that as we're doing this and just looking at the major data points that we forget some of the most serious but par certainly and i guess you could say are quality of life issues that occur with patients who are cancer in general. so i think that's also one of

the problems of doing the population health and then moving forward a number of years ago people did the population health on the asian-americans and found that well they're very affluent and very healthy group and the data here sort of reflects the same type of feeling. but again i think the problem is in the termination it is actually a hodgepodge of groups that in fact when you just aggregate have real issues in immigrant community is a lot different than an asian being up in pacific heights and this does not capture that right now of course with the issue of our economic and people resources targeting some of the most

egregious issues are important. but i think we mustn't forget the other areas that are really important that have really high incidences within their subsets . the vietnamese for example are quite different in their cancer susceptibility and at and likewise in heart disease where you know the immigrant versus or the smoker who has you know higher or a socio economic risk factor. so this doesn't take into consideration and i'm not sure how one does it as a first cod but i think this could be by itself forgetting the sub populations that within that within the poorer districts here for example are not really going to get captured

and they're not going to get the services they need. so it's i think an issue of equity also to be able to look at that as an issue and particularly because the asian population is not the same genetically or even racial and and i'm not sure where the filipino population ends up in this list but but i think did we have to segregate the pacific islanders and i think that shows they used to be combined in the asian as asian pie. yeah. so it's really important especially with the city with it being a third asian that we don't forget the sub units within this that actually also require our attention. yeah no i we completely agree and i do think and as jenny was speaking to a lot of these get

lumped together whereas when you disaggregate especially in the asian american population which we used to be long for the aapi community right so it's even bigger a group but once you start to disaggregate to very specific asian populations you will start to see disparities that would not see as the entire group. and so this is part of the work that the department needs to continue to improve on really being able to disaggregate and see where we see those disparities. >> and i will say even though like these are top three things that we are looking at, clearly there is going to be ongoing work across the department for diseases that really impact all sorts of different committees. so for example the hepatitis work and the work to get that out into the asian community. and then in terms of some of the other things on cancer, the screening work that we have to continue to do and whether it's colonoscopies or you know, mammograms or other ways that we need to ensure that our all

our populations are getting the appropriate screening so that's not to say that, you know, those are not important. in fact, there's lots of metrics around that around our whole network that we can definitely you know and we want to make sure that those are also getting met because if you focus on one thing but let the other things go that's not also going to be a successful strategy. this is just more where we are seeing very profound, persistent or they are causing death in a way that they have not caused us like the overdose mortality data which is it's coming down but that disparity continues. so that's to say that it's a not a but but it and that we are also going to focus on these three as as a total population but we cannot take our eyes off of the other issues that impact all different sorts of populations. >> yeah, no, no, i think that's a very good approach but i think we have to remember i mean we asians i think we're going to find a disparity in the death rates for example. yeah.

you know using the right parameters and that then that becomes a focus target and i don't know how you might report that in the future but particularly i think within i mean it's like grouping well it doesn't work because it's a government grouping. yeah exactly. and so i'm very concerned that the various large asian groups and their illnesses are not forgotten. yeah. and we will continue to work and see how we can get to those populations. >> but thank you very much. other commissioner questions or comments commissioner christian thank you for the presentation just a question on the community survey responses by demographic page what can can you give us any information about how the community has responded to these categories? i know that you probably i mean they're they're more inclusive

here than you know as a summary maybe probably than your survey . but is first of all, is there a place where a person could drill down a little more let's say on that first line the air and or and hpi and to see what what categories are in that and how many people checked any of those boxes and the platform would allow us to do that. i think this is we're still figuring out the platform the best way to use it. i do think yes, we have ways to go in how to represent the subpopulations particularly i mean we get feedback from the community all the time. you know that it's just a matter of capacity and also the systems that we're in. but i think with the the the voices we have more flexibility there versus our medical records system and other regulatory requirements. but yes, and there's there's a whole nuanced way i mean yes, especially with the api community as well even language

we're not picking up those things. so we don't yeah. so i mean i never try to look at the census or and be categories for like to see myself because it's you know it's very it's you don't find yourself but it's hard because you're trying to you need to use it for regulatory requirements. all our divisions have to report out certain ways and then trying to also balance picking up these other communities subcategories and also to training people to do it in a way you just can go ask people and hand it to them. they need more help. they might not trust you. so there's you know, having that culturally responsive way linguistic as well. i mean also to certain groups like the indigenous community for example, it's it's 50% of them the community estimates is like low literacy so they don't read and also their language is not it's only it's not written so i mean it's a lot with you know every community working with to kind of take those things into account and how do you collect the information these surveys are they paper or are they electronic both

in person? >> yeah, both yeah. and then it's we've been doing it i mean ideally you could do like other other health departments do different ways like scan codes but we were doing it through the town halls and like trusted groups already that they had so that the community based organization would be our introduction to them and be the trusted partner because if we come in and say we're the government, we'd like to help you, that's not going to really go out with them. so you know the category multiethnic 40 you know 40 people i mean be so interesting to know what people how people present. yeah. and describe themselves. yeah no it definitely will work. it's something it's a long term issue project. i think you and the other commissioner questions or comments all right. >> well not only do we appreciate this report, it was just excellent and extensive but what i'm hearing from the commissioners is we're really interested in what you have to say about specificity both for programs and populations and i

know it would be interesting next time i know some of these programs like the va hypertension program has been in existence for a while. i believe we were we had some great accomplishments and then we backslid so we'd love to know more detail about, you know, what programs exist, how you're extending them, what your analyzes are because this is so interesting and there's such great potential here to both, you know, understand populations that need specific management but also to understand what's really working and what might need some correction. so we're very appreciative for the work and it's it's as i said earlier and incredible progress. so thank you so much. >> i actually had one more comment. if i may. >> absolutely. i just i guess want to again just reemphasize how important even even though we're just starting on in some ways on getting better at this and more inclusive and that the the emphasis that we're placing that san francisco is placing on health equity in the face of

all of the assaults on equity you can even say the word sometimes in some places is is just remarkable and i think that it's important and in the thoughtfulness i think that just in terms of your answers that is evident in and the commitment that's evident to health equity is is something i think we we can't take for granted and we can't emphasize enough in terms of how important it is for a city like san francisco to not only do what it's doing but to lead without fear in this area. and so because i you know, the days will come when it'll be celebrated again and we will be ahead of the game. and so all the support that you need and you know, hopefully

that position will get approved and you won't have to do double triple duty of even that. but you've done a great job and the team is doing a great job. so thank you again really appreciate that. >> thank you. thank you. all right. so the next time on the agenda is the office of compliance and privacy annual report from gary chatfield who's the acting director of the office. >> thank you. good evening, commissioners. thank you. i'm garfield, the acting director for ocp. thank you for having me tonight to give you our annual report on the activities for ocp. >> and if you know my s.f. gov i have another presentation on please pop this up. >> please let me know if you can't hear me here. i'm going to circumvent it and just go this you continue okay? >> sure.

so i just wanted to start off with you go to the next slide. mark with what we do right so the the iso compliance and privacy fairs is tasked with really four main objectives protecting patient privacy, making sure that we are keeping patient information confidential and secure, making sure that we're in compliance with all the government payers mostly medi-cal and medicaid or medicare and medical and then of course ensuring that when we share our information with our partners, our community partners or other providers that we do that in a way that's legal and then we are also the part of dpa that does the whistleblower investigation and on behalf of the comptroller's office through their whistleblower program. so i just wanted to give you a couple of highlights from last year. one thing that we did over the year and actually this came out of the meeting with you all from last year was to engage more with our cbos in the dhs space. >> so the compliance office has initiated monthly provider meetings where they meet with

providers. they can come as they as they need help and documentation on claiming and just have that conversation going and to help them understand what our role is as the compliance auditors for them we also spend a lot of time making sure our training our annual training is up with the numbers that we had over the past few years and compliance and then making sure we developed towards the end of the year we developed an internal reporting system so that we could be in alignment with dpa and using data in a way internally that helps inform our own decisions and how we engage with the department as well. so we started collecting data on our privacy breaches so we can report on that better as we go forward in this fiscal year. the next slide is just the organizational chart to show you where we are. we're in the operations division under danny louis who's the chief operating officer who reports up to the director the current chief integrity officer who is the person and the director for the

cpa, the office of compliance privacy affairs is vacant due to a retirement. >> and then the organizational chart is just so you can see how we divide ourselves up. we kind of keep ourselves in a compliance team and a privacy team along with the whistleblower investigator and then we have a staff member who focuses on our education and outreach activities. >> so i'm going to move into the compliance program overview . the main focus of the compliance program is really to protect the revenue that we that we claim right to make sure that we don't have to pay it back when there's audits done from the government. so over last year we had no fines. there was nothing that we had that was a penalty. we did have to pay back just over $300,000 in tax allowances. but as you see that's been going down year over year. so a few years ago we were over $2 million in tax allowances and we're down to well under $1

million in tax allowances and that is not totally due the compliance because we work within the departments. of course it's a lot of work to ensure our documentation meets the standards so that when we submit the claims and they're looked at by government auditors that we can retain the payments that we that we sent in for the services. >> the next slide talks about the compliance program over at behavioral health which operates a little differently. so the the compliance programs that operate within primary care and population health and at the two hospitals are internal right? so we do internal reviews so we can see where we need to correct issues that we may determine would be a problem for us when an auditor looks at them. compliance office for behavior health does that as well. but they're also auditing auditing our cbo partners sort of as if they were dhs, right, because we're the mental health plan for the county. so they're looking at what they're doing and then sort of

assessing whether or not they have what we call errors or just allowances right from. >> so over the last fiscal year the overall error rate for our cbo partners was around 11%. that is down from the year before which was around 13% and is in line with sort of a national standard. so we looked at the cms perm audit error rate for mental health and ssa substance use services and that error rate nationwide is around 10%. so our cbo partners are in line. so when you look at that 11% they think okay, well obviously that and we do want that to come down but it is in line with what's happening across the country. the mental health services error rates around 8% which is about what it was last year for substance use services. that error rate was 22% which is down from 31. and when i talk about error rate that means claims that had something in there that was fatal to it that would cause a

disallowance right 40 about 40% 39% of all agencies had no error rate meaning everything was fine and then 57% of all agencies had an error rate of 10% or less. right. so the majority of them have a low error rate. there are some outliers that we do have of course on the next slide we talk about the completed audit. >> so this year we did so i put my glasses back on 28 completed audits. we were a little less this year because we had a hiccup with when epic was turned on for the cbo's there was a point at which we weren't really auditing them just due to some technical issues that covered about 222 claims. so these numbers is covering about 222 individual claims and these numbers are just kind of showing the comparison that i went over in the last slide sort of from this fiscal year over the last fiscal year. so substance use services of course we have a little bit of work to do to make sure that

those claims are the error rates are coming down when we find these error rates in the cbo space for behavioral health ,they're issued corrective actions so they may have to do internal monitoring and reporting back to the compliance office. we may go back in and look to make sure that they're kind of following the recommendations that we did. will offer them guidance on documentation and what we found whether it was like a you know a lot of the errors have to do with the wrong procedure code or maybe an assessment being missing or something not being done the way it should have been done. >> in no way should it reflect the quality of the service because that's really now what compliance is looking for. >> we're looking forward. does the documentation support you getting paid for? you might have done it and provided great care. you just forgot to do the assessment or put it in on time. >> a lot of times it's just not done timely. okay so so as part of compliance we also do some mitigation efforts.

we try to do some education through newsletters and other other methods clinician training for billing codes and procedure codes and things like that. of course we do our internal reviews strive to detect issues before someone else does and then looking at sort of working with the compliance committees in each area so each area has its own compliance committee that works with the compliance officer to address the issues that come come up. >> okay. i'll move on to the privacy program. >> so the privacy program of course its main goal is to protect all the data that we have with patient information in the protected health information as well as confidential information that we that we do. we were issued no fines over the last fiscal year either from any of the reported privacy breaches. sometimes there might be a delay in fines but there have been none to date and the reported ones that we did for

last year. so the next slide just shows you a year over year comparison. >> you can see that our reported incidents that to us and the ones and the incidents that we determine are breaches that need to be reported are increasing. part of that has to do with our own outreach that we want to be told what's going on so we can look at these issues but we're also trying to assess this is part of collecting the data a little bit better to understand what exactly is happening, what's causing these these these sort of this uptick that's going on and so that we can address that and try to bring it back down. we want people to tell us of course, but we want we want a big number of incidents being reported and a very low number of ones that we actually have to report to the office of civil rights as a reportable breach. so the second chart just kind of shows you year over year the percentage of incidents that got reported that we determined were a breach and had to be reported to the federal government or the state.

and this year 31% of those incidents were reported. >> and then the next slide just shows you by division the sfd of course just because it's our largest sort of provider of services has the largest number of incidents that get reported although percentage wise they don't have the largest number of reportable that comes out of the cbo's the cbo's report to us when there's issues and then we look into what's going on. so this just gives you a breakdown of reportable breaches versus the total incidence and the percentage of those per area that occurred. >> okay. and then the next slide is just for you to kind of see generally our largest our largest pain points if you will for bias and unauthorized access is by far the largest that staff people staff members looking at things where they show that they don't have a

business purpose to do that. and so our efforts will be look over this next fiscal year looking to address that education other measures that we can implement to try to understand what drives that. most times that is curiosity over maybe someone who's high profile or something like that but we want to look and see what's going on there. unauthorized disclosure happens usually pretty inadvertently we give somebody the wrong information and we say something out loud that we shouldn't in front of other people. so looking at what kind of causes that as well so this data hopefully will improve since our reporting of the data has improved and we can look here we can start to look this fiscal year to last fiscal year to see what might be changing and then similar to compliance we do other issues, we do other mitigation efforts in the same way with education internal review we do our internal access audits which is where we do find some some issues with people looking at things they shouldn't do.

and then we're exploring this year privacy monitoring software to automate that to some degree to help us detect things as they happen and hopefully have people understand that you know, right now with the manual review there's literally two people who will pull the reports and look at them that only scratches the surface. so if we have something in place that can kind of look through epic to look for patterns, hopefully we can put the message out that you know, please be careful. you know, only do what you're supposed to do because the software will catch things like that. >> okay. and then i just wanted to go on to a few of the other focus areas for ocp. so we do have a hotline the hotline takes in all kinds of requests not just compliance and privacy issues. the department uses that really to to triage any kind of complaints or whether so if we don't look into it, we'll triage it out. we saw a little bit of a

decline in the number of people reaching out to us over last year was down about 300 or so. that was actually due to the training. we got better at telling people how to use the system and so we had less inquiries about that which is why that had gone up over the past couple of years a little bit. okay. and then speaking of the training we do the annual training every year you all get your compliance training tonight and then year over year you can see we're holding kind of steady as far as completion rate goes the year that it shot up from 60 with a 6,058% to 98 was when we implemented the we look to shut someone's epic access off if they haven't done it and so that has helped ensure the compliance rates are kind of high. so we do a tremendous effort every year it here to make sure everyone is done their training

so that we can do that. it's important people ask why do you care so much? it's important because when we report a breach to the ocr or cdp they're going to look at that and they're going to see well if you're not training your workforce, what are you actually doing to help mitigate the issues that go on? so it's important for us to try to keep that training going every year and then the data sharing of course is making sure that like i said before that we're sharing information in a way that hipa permits when we engage with our community partners some of the highlights that we worked on was centralizing and organizing the mou throughout the department. a lot of over years disparate places had set up mou with other city agencies or other partners and we centralize all that so that we can find them and understand when things are expiring and then working with contracts a little more closely to ensure that they understand when contracts need to have certain provisions in there

about sharing that data and working with us on that. and then there are some claim data sharing needs that we were working on this year as well. and then the last item for this part is the whistleblower program and unfortunately because of the way the whistleblower set up i can't give you a lot of details i can report out on the publicly available information page is the whistleblower's largest customer. they get the most complaints from us or about they received 144 of the last year they will we don't investigate all 144 they'll try out for the comptroller's office, treehouses them and then they will send over they'll kind of determine whether or not there's some merit to it and the ones that do they'll send over for us to investigate and then we do the investigation, send the report to the comptroller's office and if there's corrective action that has to happen we then follow up internally with the appropriate place in the department whether it be labor

or the division that the issue was came up from that is the end of that. i'm happy to answer questions on this part before we go on to the other section. >> they're different items so we have to yeah, yeah no problem. okay. well thank you for the report. this is a tremendous amount of work and analysis. here is there any public comment in the room? >> i don't see anyone any remote public commissioner questions or comments in this report to vice president kimmel. >> thank you for thank you for your presentation. i'm glad to see that there's been some progress in some of the areas. i had a question about privacy she's so in the finance and planning committee we looked at we were looking at a proposal for ai assisted voice recording of and so i was just wondering how your office is going to be looking at or

working with these new technologies that might potentially need different types of training or considerations around privacy. that's a great question actually it's coming up a lot so contracts and it work with us. we all work together on these issues so that we can understand what measures are in place to protect when either protected health information, patient information or even personally identify like financial or social security numbers are going into these systems and how they work, right? so a lot of it depends on what the system is doing to protect that data and how we're setting up the agreement to ensure if there's an issue that there's responsibility on that just like we would with any other any other electronic system that we work with, there'd be a legal agreement between us and them to ensure if something were to happen how that's going to be handled. but more importantly we want to ensure that there's technical safeguards in place in these

systems to not let that information out into the world right. and that's just a matter of reviewing each one to determine what they're what it's doing right because that information you don't want you don't want your social security number or your health information being fed into a generative ai program that it's now using machine learning to learn. right? so like for example microsoft copilots, which is the city's system that's been set up in a way that protects that information so if it does go in there it's one it's not a breach and two it's not going out and being used in that sort of machine learning method. i'm not at here so forgive me if i'm not using the right language but but but the protections are in place within the software to ensure that that kind of information isn't being used as the model for learning. that makes sense. i hope so, sir.

>> want to be continually vigilant about how these technologies are changing. >> yeah. and fast. yeah. yeah. commissioner christian, thank you for the report on the auditing the random auditing i'm assuming that this is system based computer based that had it. can you just given a quick overview of how that kind of auditing takes place approve use of file and you know in contravention of hip or something like that or need sure. >> so so for privacy or compliance or both for both. >> both yeah. so i'll do compliance first. so compliance is the compliance officers would sort of either they're going to have an idea that they need to look at something through either someone telling them or maybe they they did some brief review on something and i need to look

at that. then they're going to do a sample size selection. i'd say like a service claims like a procedure code, a cpt code they may pull whatever the statistics the relevant sample size is to look at they're going to look at what resource required under that code and ensure that the documentation supports that would be like an example. so that's really just a manual review. so they're going to pull a report of course to find out yeah of course, yeah it's going to come out of epic they'll pull a report but they're going to be manually looking at that right currently for our privacy audits it's actually similar we'll do we'll pull a report on people's access and we'll look for we'll look for patterns that look how do i put this unusual right? >> so somebody maybe somebody who is let's say for me i'm not a clinical person all of a sudden gareth's looking at a matter clinical records, right? and in the emergency room that would be something we are willing to look and see what's going on there again that we

can review. so we're going to pull a report to look at like are they accessing records that are outside where they normally work and then start and then start looking to see what's going on that's how that helps. the software that i was talking about would automate that part of it so we would be able to pull every able to like really sort of pull across epic right ? we're just pulling reports at this point of a smaller size of patients because it's it's people doing it but what would happen is we can get a much more detailed report that can pull automatically like here are ten patterns that are suspicious. >> you need to look at what's going on. thank you. sure. any other questions or comments? all right. >> seeing none we'll go to your next great. thank you. we know it's going to be the commission annual compliance. >> yes. and thank you for having me to do this again. i know we've been doing it for

a couple of years for you and i hope that you know it won't be boring for clients. >> i'll do my best to keep it entertaining for one second. >> sure. okay, great. great. >> okay. all right. so overview of the training just for your sort of information what we're going to do i'll talk a little bit about the the compliance program, our code of conduct, conflicts of interest, your responsibilities as the oversight body for the health department, how you recognize and report concerns and then the consequence of compliance investigations. >> so the overview of the program so as i stated in the last presentation, the main goal is to make sir, that we are working in a way that is ethical and with integrity and that we're entitled to the services to payment for the services that we claim for from the federal government, right? they want to make sure that

they're guarding against fraud, waste and abuse which i'll talk about in a little bit. so we do that by promoting an understanding of compliance through the health care or sorry through our compliance committees at each site through an executive level compliance committee through the education that we do with staff and working with providers and managers to help them understand how to work compliance and their day to day as well. >> so we operate the compliance program in accordance with state and federal standards so that we can detect and prevent any abusive activities that might happen. we base that on the office of the inspector general's seven elements and i'll go through and ask for you. the seven elements are the oig is sort of a position that if you're doing these you're going to have what they call an effective compliance program or as effective as possible. >> there's no blueprint,

there's no oig. >> this is how you have to do it. they say you the health care organization know how you operate. you can implement these in the way that makes sense for you. but we're going to look to see that you're doing these in some fashion. right? and so the seven elements are having a compliance officer and compliance committee does that through its chief integrity officer and then the compliance the executive level compliance committee as well as the site compliance programs and then you should have policies and procedures that promote the commitment to compliance and help address risk areas things like conflicts of interest as well. you should have open lines of communication meaning you have a way for employees to report issues that they may have, right? so anonymously, confidentially whoever however they feel comfortable doing it you have a method for them to do it

training and education of course which we do annually and then monitoring. so you should be doing some sort of internal review of your services to make sure that you're not that everything is sort of in line with what's supposed to be happening to respond to anything that you find wrong and correct them as fast as you can and then of course have a standard of conduct and discipline standards for issues that occur. okay. so what the federal government and the state cares about is fraud, waste and abuse. >> but the next one fraud is the intentional misuse of federal money or state money, right? so somebody is doing something on purpose to get money that they're not entitled to like knowing knowingly billing for a service you didn't provide is a sort of classic example. >> waste is older ization of services so using things in a way that's careless right? you're running unnecessary tests right or you're letting

supplies of medication expire, right? you're just not being a good steward of the money that you receive. >> right. and then abuse means provider practices that would be considered improper right? so doing something potentially medically unnecessary, something like that. so those are the things that a compliance program is always trying to look at and detect and prevent from happening. >> okay. so there's a few health care laws and regulations sort of govern all of this. the false claims act is a federal law and that is the one that really talks about preventing fraud, waste and abuse. the fraud enforcement recovery act as sort of an add on an add on that happened around the time of the aca and sort of expanded the enforcement provisions of the false claims act and then there's a state version of that called the deficit reduction act that kind of deals with medicaid payments, medical issues which we fall under because we bill more than $5 million

in medicare or sorry in medicaid money from the bottom line is all of them are caring about reducing fraud, waste and abuse and putting it on the organization to make sure that they have measures in place to do that. okay. >> the code of conduct is a policy that a compliance program needs to have to ensure that you're encouraging best business practices basically it describes our commitment to conducting business in a way that's ethical and with integrity and it outlines the sort of standard of conduct that we expect employees to have as well as the officers of the commission. you can go to the next slide mark. >> so the key points of the code of conduct are to work honestly and ethically and responsibly respect the privacy and confidential liberty of our patients, follow all of our departmental policies, conduct compliant billing and purchasing practices, promoting respectful

behavior between staff and between managers and staff being respectful of patients and clients and everyone that we encounter on a day to day basis. okay, i'm going to move on to conflicts of interest because that's an important for you all as decision makers in the policy body. >> so a conflict of interest really involves any circumstance where you as a city officer or an employee has a personal or financial interest in a decision you're making on behalf of each right? you can have an actual conflict or you can have a perceived conflict actual conflicts. you know, obviously you'd want to avoid those and in all cases a perceived conflict can happen and sometimes it's best to recuse yourself even if the law says it's okay, it might appear to be it might appear to be a personal benefit for you. the classic example is making a decision unlike a contract in which you or someone you

your friend or a family member has a financial or interest in and making decisions on that would of course be a conflict of interest. but really it's anything where you're exploiting your position for a personal benefit. other examples of that would be having a super sort of decision making authority over someone you're related to or have a close relationship with or asking people who are government employees to do personal things for you right? >> so i don't know go pick up my laundry. right. i think that's at anytime time things like that that's a personal benefit that should be avoided as well. other conflicts of interest are accepting gifts. that's a really broad category that we're not going to get into a lot. the bottom line is as a public official you should always think about can i accept this or not your position as a public official might affect that. i'm depending on who it is the

hard rule about gifts is if it's a restricted source meaning someone doing business with the city you would you would be prohibited from accepting anything from somebody who falls under that category. there are a lot of exceptions which if you ever do have questions please feel free to reach out. but i always like to tell everybody when i talk about gifts just think i'm a public employee. i'm a public official. let me just think who's is coming from? what's the circumstance and should i ask if it's okay? >> oh okay. your responsibilities as the oversight body right. >> so you should be aware of all government regulations around reimbursement of services. i've given you some information tonight but it's your responsibility as a governing board to understand what those are. to apply that understanding and evaluating the adequacy and the performance of everything that we do it is to

monitor the fiduciary duty of the department and provide oversight for that evaluate the structural and operational effectiveness of not only the compliance program but of the department as a whole. you should act in good faith in the exercise of that responsibility for dupage including making inquiries to ensure that the reporting systems that we have to you are timely and attentive and give you the information that you need. >> okay. we also ask everybody who is a public official or an employee to comply with all the laws that we talk about including the code of conduct and any other city policy that applies. understand the scope and practice of your licensure or your position. >> avoid any action or activity that could be a conflict of interest and disclose those and let people know what's going on and then actively into activity sorry actively participate in compliance

activities such as the training and other things everyone has a duty to report you as commissioners me as an employee if i detect something going on i need to tell somebody right? if you think something is going on you need to tell somebody. there's lots of avenues to do it. you can go right to the comptroller's office, report it there. you can come report it to our hotline. you can contact the chief integrity officer directly. you can go right to a regulatory body. >> you can go right to cdp. it's dhs. there's lots of ways to do it. the bottom line is if you think something's amiss or somebody is doing something that could be fraud, waste and abuse, it's you should report that even if you don't know all the details ,if you have a suspicion of something happening. >> okay, compliance violations obviously internally there can be discipline but you can be fined if you're i mean actually you can go all the way to

criminal penalties that there's monetary penalties as well that the federal government and the state can impose for anybody who's found culpable in those things. >> i think that's it. >> oh yeah, that's it. and then lastly i just has the hotline information for you also you have that if you if you hopefully never need to but if you do you have you can do it. all right. any questions? well, thank you for the review. >> i gather there's no public comment or any commissioner questions or comments. >> all right. we know what we're supposed to do. excellent. great. all right. well, thanks for having me again and please do reach out if you ever have questions, sir. >> thank you. >> okay. the next item on the agenda is the finance and planning committee update from commissioner chao. >> uh, q we actually had looked

at three contracts in the contracts report. two are amendments for term extension from san francisco health aids foundation which is a health access point program and the ymca doing urban services. a third one was for ucsf and it's for a citywide court program. it's a new contract but performing previous services it's a combination of two contracts and a low a little lower in price. >> the four new contracts were quite innovative and were different. the first one was a contract with ucsf to perform day treatment intensive and especially mental health services through an intensive outpatient program. >> this is a new program mandated by the state. this is part of also the a

outpatient to be integrated with the inpatient services for mental health that is being built out in building five under the state grant that the city received. you remember we received a report several meetings ago about the success of the grant so that would be an inpatient service. this is an outpatient service as a separate contract which will be integrated into the affiliation agreement. one city inpatient service also opens so i'll be part of the use a ucsf affiliation. the second new contract with was with a come here incorporated. >> this is a software program sort of a i where with the patient's permission the patient interview and a visit is digitized and then approved or edited by the provider here

and is then put into the record so that presumably your provider will not have to write out or dictate out a note but have a note prepared for them. so this is an interesting approach and we have asked also on its approval to have a six month update on the acceptance of this a third contract again more innovation works with virtuoso theft which is basically to digitize our enterprise workforce and talent management particularly for the nursing staff so that this could be tracked and and the issues of the overtime for example one per diem is can then be also looked at and the

absences of nurses and so forth. so case it it digitize a very manual process at the moment and that's worth 9.9 million for five years. >> lastly is a state funding for a program that the state had mandated we do for a jail health mentally unable to stand for trial and requires that the city provide services for those people who are incompetent to provide to stand trial. so this is actually the state funding that now comes to allow that the state actually will be sponsoring about 16 of those cases. so all four are also before you for approval all lastly

and perhaps with the greatest long term significance we are in the process of reviewing the protocol for review of contracts and the work of the financing committee and over the next several months will hope to work with administration and our executive secretary to potentially develop a new policy that will be hopefully more streamlined and efficient so that we can continue the work of oversight on the commission for our contracts and yeah and other important topics we're looking also at doing it by either topic have large contractors or of special services or different groups or whatnot. so all of that is open if you have any suggestions provide them also to our executive director here so that they can also be incorporated in the

discussions and we're hoping agenda is this on a monthly basis? >> well thank you for the report and gather no public comment any commissioner questions or comments a commissioner toronto i just have one question and it may just be how the sentence that when i reviewed the uk self assessed new funding for adolescent mental health which was the iap yes it's an iap and a p is what i saw. it was both the post hospitalization program and the iap that could well be accurate. i guess that's what the grant said. >> oh well that's what when i read the fine print the what we were were i think what we're being asked to approve is the

initial iap and then when the p and that there's a third element are are ready for a four are ready they'll be incorporated into the affiliation agreement along with the iap but right when the renovations are continue finished and the i p part apparently begins this is for the outpatient services currently and i was looking the p will be the post hospitalization program will be on the when the renovation is yes completed but this grant is for both it's just for the iap okay because right i think that states it right and i thought when i read the whole grant proposal yeah yeah i will get clarification tired from the staff too because the when i read the grant proposal does include that but this contract

is especially for the outpatient services that will begin before even the completion of the inpatient services and any post write hospital so i know the inpatient is when it's right and so that part will come so it'll just be later but the grant then covers the full grant covers also the construction that's what i'm asking. >> yeah right. >> but the contract you're looking at today was only for the outpatient. that's what they talked about today even though the grant might fund differently what you all are there's a very specific thing you're doing today and that's the outpatient which i. >> i hope you see. i hope. yeah, yeah yeah. it's just because when i was reading it we have asked them about the iop part they had talked about this grant or this contract includes a 30 day follow up but they are actually committed to looking at how they will continue to follow those who stay in the program longer than 30 days which is

great. so the the ip will happen when inpatient is completed. i will get new contracts for that and then some of that looks like you'll get assimilated into the total affiliation agreement with you see is that okay? other commissioner questions or comments? all right. >> oh go ahead. just a reminder, mark, there's two items contracts that we're going to be voting on for ucsf so i have to recuse myself. >> so how we do that thank you for reminding me, commissioner how we do that then is those items need to be separate out so there needs to be a motion to separate out the two you see items separately and then everyone can vote on the consent calendar including you and then those two separate items everyone else will vote on and you will recuse yourself. so we need to start with separating out the two you see perfect. all right. so we have before us the

consent calendar and we're being asked where we will first take a motion is second to approve items three and four and one, right? >> yes. one three and four. is there a motion to approve so moved is there a second second is there any public comment? there's no public comment. >> all in favor please say i. i are now we will address approval for items two and five. is there a motion to approve so moved is there a second so i can enter and then all who can vote who are in favor please say i i wonderful thank you. and commissioner salgado i'm going to send you a form that you i to fill out and gives the ethics commission them every time you recuse yourself you've got to just note it. >> thank you. thanks for reminding us. >> thank you. any other business hearing none and no public comment on that item as well. >> right. we will entertain a motion to go into closed session the moved is there any public comment on public art?

>> all in favor please say i i okay and online. >> okay hold on. we're about to take live and then we need to do that stuff to okay so speaking of tv, we're back online commissioners please. >> so in closed session we discuss my evaluation and please consider a motion to disclose discussions held in closed session or not. >> second, all in favor. >> right. all right. and please consider motion to adjourn. >> so moved second all in favor

. >> all right. thank you everyone. thank you. thank you pen. >> well to edge own little square we are a new culture "accelerating sf government performance - taking accountability and transparency to the next level." the artist and culture of chinatown. as an

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. hello. i'm andrew murtaugh of the san francisco fire department. we're here at fire station seven today. we're going to talk to you about some of our fire apparatus specifically we're going to talk about the ladder truck and the san francisco fire department. it's covered by 20 ladder trucks. those trucks are staffed with 1 in 4 which means one company officer either captain or lieutenant rank and four firefighters among those four firefighters. one is the apparatus operator or the driver and one is the teller operator or the teller. >> the other two firefighters sit in the back of the cab. the apparatus operator is responsible for the tractor and the aerial ladder.

the tiller is responsible for steering the trailer, making the truck more maneuverable and maintaining all of the tools and equipment. >> trucks are very versatile machines that carry an assortment of tools and ladders . >> in the san francisco fire department. we have seven cardinal points that describe the operational objectives of truck companies. >> those seven cardinal points are search and rescue ladder in the building ventilation forcible entry overhaul salvage operations and control and utilities. let's break each of those seven points down ladder trucks are often tasked with performing rescues especially from upper floors whether it's using ground ladders or the aerial ladder. our job is to reach victims who may be trapped by fire and smoke. we also assist with victim removal from windows or rooftops when necessary. we use items like this thermal imaging device to see the victims through the smoke and remove them from harm. the primary responsibility of

the ladder truck is setting up ground an aerial ladders. this provides firefighters access to upper floors for fire attack and rescue operations. it also gives us an escape route if conditions worsen inside. ground ladders can be deployed quickly while the aerial ladder provides a fast and stable route for multiple firefighters or victims. the trucks are equipped with a fixed 100 foot aerial ladder capable of reaching the seventh floor of a high rise building. the ground ladders range from a six foot step ladder to a 50 foot banger ladder with poles that weighs 350 pounds. it takes six firefighters to raise all of our ground ladders are handmade out of hickory ash and douglas fir here in san francisco and some date back to the early 1900s. ventilation is one of the most important tasks for a ladder company. we use horizontal and vertical ventilation techniques to remove heat, smoke and toxic gases from the structure. proper ventilation improves visibility reduce the risk of

flashover and makes the condition safer for interior crews. when we arrive on scene of a working fire we immediately send truck companies to the roof to prepare for vertical ventilation. firefighters use chainsaws as rotary saws and axes to open up the roof. the ladder truck crew is responsible for forcing entry if needed and ensuring clear egress routes for the crew inside. >> we use various tools including power source halogens ,axes and key tools to make entry or secure windows and doors for rapid exit. the aerial ladder is also a crucial means of escape from upper floors. truck companies will assist the engine companies in making entry into the structure so they can focus on getting a working hose line in place to contain and extinguish the fire. >> once the fire is under control, the truck company plays a key role in overhaul. we check for hidden fire walls, ceilings and other void spaces. the ladder truck gives us access to the roof, attic

spaces and other high risk areas where embers are hotspots might linger. firefighters will use thermal imaging cameras during overhaul to detect hidden heat sources quickly. firefighters carrying ceiling hooks to reach high ceilings and halligan tools and access to open up interior walls. finally after fire suppression and rescue operations are complete, we perform salvage. the goal is to minimize property damage to recovering furniture and valuables with tarps moving items away from potential water damage and controlling the flow of water from fire hoses and sprinklers. >> during fires the truck company is responsible for controlling utilities, gas, water and electricity. these steps are essential to prevent explosions, electrocution or other worsening conditions on the fireground. >> in addition to our seven cardinal points truck companies also respond to vehicle accidents to perform extrication of victims. >> high angle and low angle technical rescues. building water emergencies.

>> building collapses. and many other call the seven cardinal points are the operational objectives of every sfd truck company and there are accomplished after we arrive on scene based on the incident priorities. and they are our guide for effective operations for the san francisco fire department. >> in summary the ladder truck is a rolling toolbox and our firefighters are trained to address a number of incidents from rescues to building emergencies. >> it's a symbol of our commitment to protecting the community of san francisco and ensuring your safety every day. thank you for your time. if you'd like to take a closer look, feel free to ask any san francisco firefighter about our ladder trucks. we're here to educate and serve our community. >> stay safe

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